Could reduced cerebrospinal fluid (csf) galanin contribute to restricted eating in anorexia nervosa?

Is there a hypothalamic basis for anorexia nervosa?

The hypothalamus has long been known to control food intake and energy metabolism through a complex network of primary and secondary neurons and glial cells. Anorexia nervosa being a complex disorder characterized by abnormal feeding behavior and food aversion, it is thus quite surprising that not much is known concerning potential hypothalamic modifications in this disorder. In this chapter, we review the recent advances in the fields of genetics, epigenetics, structural and functional imaging, and brain connectivity, as well as neuroendocrine findings and emerging animal models, which have begun to unravel the importance of hypothalamic adaptive processes to our understanding of the pathology of eating disorders.

The regulative effect of galanin family members on link of energy metabolism and reproduction

It is essential for the species survival that an efficient coordination between energy storage and reproduction through endocrine regulation. The neuropeptide galanin, one of the endocrine hormones, can potently coordinate energy metabolism and the activities of hypothalamic-pituitary-gonadal reproductive axis to adjust synthesis and release of metabolic and reproductive hormones in animals and humans. However, few papers have summarized the regulative effect of the galanin family members on the link of energy storage and reproduction as yet. To address this issue, this review attempts to summarize the current information available about the regulative effect of galanin, galanin-like peptide and alarin on the metabolic and reproductive events, with special emphasis on the interactions between galanin and hypothalamic gonadotropin-releasing hormone, pituitary luteinizing hormone and ovarian hormones. This research line will further deepen our understanding of the physiological roles of the galanin family in regulating the link of energy metabolism and reproduction.

Central and peripheral peptides regulating eating behaviour and energy homeostasis in anorexia nervosa and bulimia nervosa: a literature review

A large body of literature suggests the occurrence of a dysregulation in both central and peripheral modulators of appetite in patients with anorexia nervosa (AN) and bulimia nervosa (BN), but at the moment, the state or trait-dependent nature of those changes is far from being clear. It has been proposed, although not definitively proved, that peptide alterations, even when secondary to malnutrition and/or to aberrant eating behaviours, might contribute to the genesis and the maintenance of some symptomatic aspects of AN and BN, thus affecting the course and the prognosis of these disorders. This review focuses on the most significant literature studies that explored the physiology of those central and peripheral peptides, which have prominent effects on eating behaviour, body weight and energy homeostasis in patients with AN and BN. The relevance of peptide dysfunctions for the pathophysiology of eating disorders is critically discussed.

Dysfunctions of leptin, ghrelin, BDNF and endocannabinoids in eating disorders: beyond the homeostatic control of food intake

A large body of literature documents the occurrence of alterations in the physiology of both central and peripheral modulators of appetite in acute patients with anorexia nervosa (AN) and bulimia nervosa (BN). Until more recently the role of most of the appetite modulators in the control of eating behavior was conceptualized solely in terms of their influence on homeostatic control of energy balance. However, it is becoming more and more evident that appetite modulators also affect the non-homeostatic cognitive, emotional and rewarding component of food intake as well as non food-related reward, and, recently, AN and BN have been pathophysiologically linked to dysfunctions of reward mechanisms. Therefore, the possibility exists that observed changes in appetite modulators in acute AN and BN may represent not only homeostatic adaptations to malnutrition, but also contribute to the development and/or the maintenance of aberrant non-homeostatic behaviors, such as self-starvation and binge eating. In the present review, the evidences supporting a role of leptin, ghrelin, brain-derived neurotrophic factor and endocannabinoids in the homeostatic and non-homeostatic dysregulations of patients with AN and BN will be presented. The reviewed literature is highly suggestive that changes in the physiology of these modulators may play a pivotal role in the pathophysiology of eating disorders by providing a possible link between motivated behaviors, reward processes, cognitive functions and energy balance.

Neurobiology of consummatory behavior: mechanisms underlying overeating and drug use

Consummatory behavior is driven by both caloric and emotional need, and a wide variety of animal models have been useful in research on the systems that drive consumption of food and drugs. Models have included selective breeding for a specific trait, manipulation of gene expression, forced or voluntary exposure to a substance, and identification of biomarkers that predict which animals are prone to overconsuming specific substances. This research has elucidated numerous brain areas and neurochemicals that drive consummatory behavior. Although energy homeostasis is primarily mediated by the hypothalamus, reinforcement is more strongly mediated by nuclei outside the hypothalamus, in mesocorticolimbic regions. Orexigenic neurochemicals that control food intake can provide a general signal for promoting caloric intake or a more specific signal for stimulating consumption of a particular macronutrient, fat, carbohydrate, or protein. The neurochemicals involved in controlling fat ingestion--galanin, enkephalin, orexin, melanin-concentrating hormone, and the endocannabinoids--show positive feedback with this macronutrient, as these peptides both increase fat intake and are further stimulated by its intake. This positive association offers some explanation for why foods high in fat are so often overconsumed. Consumption of ethanol, a drug of abuse that also contains calories, is similarly driven by the neurochemical systems involved in fat intake, according to evidence that closely relates fat and ethanol consumption. Further understanding of the systems involved in consummatory behavior will enable the development of effective therapies for the treatment of both overeating and drug abuse.

Galanin and consummatory behavior: special relationship with dietary fat, alcohol and circulating lipids

Galanin (GAL) plays an integral role in consummatory behavior. In particular, hypothalamic GAL has a positive, reciprocal relationship with dietary fat and alcohol. In this relationship, GAL increases the consumption of fat or alcohol which, in turn, stimulates the expression of GAL, ultimately leading to overconsumption. Through actions in the amygdala, this relationship may become especially important in stress-induced food or drug intake. These effects of GAL in promoting overconsumption may involve various neurotransmitters, with GAL facilitating intake by stimulating norepinephrine and dopamine and reducing satiety by decreasing serotonin and acetylcholine. In addition, GAL in the hypothalamus stimulates the opioid, enkephalin, throughout the brain, which also promotes overconsumption. The relationship between GAL, fat, and alcohol may involve triglycerides, circulating lipids that are released by fat or alcohol and that correlate positively with hypothalamic GAL expression. In females, levels of endogenous GAL also fluctuate across the reproductive cycle, driven by a rise in the ovarian steroids, estrogen, and progesterone. They peak during the proestrous phase and also at puberty, simultaneous to a sharp increase in preference for fat to meet energy demands. Prenatal exposure to a high-fat diet also enhances hypothalamic expression of GAL into adulthood because of an increase in neurogenesis and proliferation of GAL-expressing neurons in this region. This organizational change may reflect the role of GAL in neuronal development, including neurite growth in adulthood, cell survival in aging, and cell stability in the disease state. By responding positively to fat and alcohol and guiding further neuronal development, GAL potentiates a long-term propensity to overconsume fat and alcohol.

Further evidence of association of OPRD1 & HTR1D polymorphisms with susceptibility to anorexia nervosa

BACKGROUND

A recent study reported strong evidence for the involvement of a region on human chromosome 1 and genetic susceptibility to anorexia nervosa (AN). A more detailed analysis of this region has suggested 2 genes that may account for this susceptibility. These data suggest that polymorphisms in both the serotonin 1D (HTR1D) and opioid delta 1 (OPRD1) receptor genes show a significant association with restricting AN (RAN).

METHODS

In the current study, we have conducted an independent association study on 226 females meeting DSM-IV criteria for AN and 678 matched volunteers.

RESULTS

We genotyped 4 SNPs in HTR1D and 6 SNPs in OPRD1. 3 SNPs were found to be associated with both RAN and binge-purge AN (BPAN) within the gene for OPRD1. We also found evidence of association between 2 polymorphisms within HTR1D and RAN.

CONCLUSIONS

These data support the hypothesis that polymorphisms within this region form a component of the genetic basis to susceptibility to RAN. However, further work is required to understand the processes that may be mediated by these genes.

How does zinc supplementation benefit anorexia nervosa?

BACKGROUND

A randomized controlled trial of zinc supplementation in anorexia nervosa (AN) reported a two-fold increase of the rate of increase of body mass index (BMI) in the zinc group. Zinc is inexpensive, readily available and free of significant side effects. However, oral zinc supplementation is infrequently prescribed as an adjunctive treatment for AN. Understanding the mechanism of action of zinc may increase its use.

HYPOTHESIS

Low zinc intake, which is very common in AN, adversely affects neurotransmitters in various parts of the brain, including gamma-amino butyric acid (GABA) and the amygdala, which are abnormal in AN. Zinc supplementation corrects these abnormalities, resulting in clinical benefit in AN.

CONCLUSIONS

Oral administration of 14 mg of elemental zinc daily for 2 months in all patients with AN should be routine.

New targets in the treatment of anorexia nervosa

The pathophysiology of anorexia nervosa (AN) is complex and involves alterations of serotonin, dopamine and histamine neurotransmitters. In addition, receptor activity is disturbed, presumably in response to the neurotransmitter changes. These alterations are reviewed in relation to symptomatology and outcome of AN. Neuropeptide and peripheral orexigenic and satiety peptide research is in its infancy but holds much promise to shed light on the pathophysiological mechanisms involved in this illness. Current drug therapies have not demonstrated the efficacy desired in the treatment of AN. Current therapies are reviewed and new drug targets are explored. Compounds that interact with serotonin, histamine and dopamine receptors may offer unique treatment opportunities. In the future, the manipulation of peptides may add to the therapeutic potential of pharmacotherapy.

Changes in cerebrospinal fluid neurochemistry during pregnancy

BACKGROUND

Little is known about changes in brain function that may occur during pregnancy. Studies in rodents and sheep suggest that several brain neurotransmitter and neurohormonal systems known to modulate anxiety may be altered during pregnancy.

METHODS

Cerebrospinal fluid (CSF) and plasma samples were obtained from 21 women (during weeks 38-39 of pregnancy) who were undergoing elective cesarean section and from 22 healthy nonpregnant women.

RESULTS

The CSF levels of g-aminobutyric acid (GABA) and 3-methoxy-4-hydroxyphenylglycolwere reduced in pregnant women. There were no changes in CSF glutamate, 5-hydroxyindoleactic acid, and homovanillic acid. There was a large increase in CSF prolactin in pregnant women and also a trend toward an elevation in CSF oxytocin. Levels of prolactin, but not oxytocin, in CSF and plasma were correlated in pregnant women.

CONCLUSIONS

These results suggest that pregnancy alters regulation of brain GABA, norepinephrine, and prolactin, which may play a role in changes in vulnerability to anxiety and depression during pregnancy and postpartum. Prolactin circulating in the bloodstream seems to be the major source of CSF prolactin during pregnancy.